我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

 非体外及体外循环下左心室运动异常型室壁瘤切除术的临床疗效比较()

《中国胸心血管外科临床杂志》[ISSN:1007-4848/CN:51-1492/R]

期数:
2009年第16卷第6期
页码:
421-425
栏目:
临床研究论著
出版日期:
2009-12-25

文章信息/Info

Title:
 Comparison of Clinic Results of Left Ventricular Dyskinetic Aneurysmectomy between Offpump and Onpump.
文章编号:
1007-4848 (2009)06-0421-05
作者:
 董然 陈宝田 刘韬帅 等
 首都医科大学附属北京安贞医院 北京市心肺血管疾病研究所 心脏外科， 北京
100029
Author(s):
 DONG Ran;  CHEN Bao-tian;  LIU Tao-shuai;  et al .
 

Department of Cardiovascular Surgery, Beijng Institute of Heart, Lung and Vessel Disease,Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China

关键词:
 ; 左心室运动异常型室壁瘤;  非体外循环;  室壁瘤折叠术
Keywords:
 ; Left ventricular dyskinetic aneurysm;  Offpump;  Ventricular aneurysm plication repair;  Onpump;  Ventricular linear aneurysmectomy
分类号:
R654.2
DOI:
-
文献标识码:
A
摘要:
 目的 比较非体外循环（off-pump）室壁瘤折叠术与体外循环（CPB）室壁瘤线形切除术治疗左心室运动异常型室壁瘤的临床疗效，以提高室壁瘤的治疗效果。 方法 2003年9月至2007年9月，手术治疗32例左心室前壁或心尖部运动异常型室壁瘤患者，其中男23例，女9例；年龄46～70岁，平均年龄63岁。根据手术中是否采用CPB，将32例患者分为两组，off-pump组（n=17）: 室壁瘤范围占左心室的25%～37%，在off-pump下行室壁瘤折叠术；常规体外循环（onpump）组（n=15）: 室壁瘤范围占左心室的27%～40%，在常规CPB下行室壁瘤线形切除术。两组均同期行冠状动脉旁路移植术。术后采用超声心动图测定左心室容积及收缩功能等指标，并进行比较，以评价临床效果。 结果 两组均无手术死亡。offpump组无围术期并发症，术后心功能分级（NYHA）较术前有明显改善（1.0±0.8级 vs. 2.9±0.3级，P=0.001），左心室射血分数（LVEF）明显提高（41.0%±4.5% vs. 36.4%±4.8%，P=0.035），左心室收缩期末容积指数（LVESVI）明显减小（52.6±27.7 ml/m2 vs.79.7±21.4 ml/m2，P=0.003）。随访17例，随访时间12～53个月，平均随访29个月，随访期间无死亡。1例患者术后1年因二尖瓣重度反流再次手术治疗，1例患者于术后3年发生充血性心力衰竭，LVEF 31%，仍在观察中；其余患者临床效果良好。onpump组围术期发生并发症3例（神经系统并发症2例、呼吸功能不全1例），术后心功能分级较术前有明显改善（1.0±06级 vs. 3.1±0.9级，P=0.001），LVEF较术前明显提高（42.3%±3.2% vs. 35.6%±6.5%，P=0.023 ），LVESVI较术前明显减小（49.3±22.6 ml/m2 vs.81.3±25.0 ml/m2，P=0.003）。随访15例，随访时间12～60个月，平均随访35个月，随访期间无死亡，临床效果良好。两组间临床指标比较差异无统计学意义（P>0.05）。 结论 在off-pump下行室壁瘤折叠术治疗左心室运动异常型室壁瘤，可有效地减少左心室容积，提高左心室收缩功能，围术期并发症少，是一种安全、有效的手术方法，远期预后有待进一步观察。
Abstract:
 Objective To compare the clinic results between offpump left ventricular(LV) aneurysm plication repair and onpump LV linear aneurysmectomy for LV dyskinetic aneurysm (DA), and to improve the curative effect of aneurysm. [WTHZ]Methods From September 2003 to September 2007, 32 patients with DA located in the anterior wall or apex of LV were operated. There were 23 male and 9 female aged 4670 years with a mean age of 63 years. According to the procedure with or without cardiopulmonary bypass(CPB), 32 patients were divided into two groups: Offpump group (n=17), with the size of DA represented 25%-37% of left cavity. Patients in this group underwent offpump LV aneurysm plication repair; Onpump group (n=15), with the size of DA represented 27%-40% of left cavity. Patients in this group underwent onpump LV linear aneurysmectomy. Coronary artery bypass grafting was the concomitant procedure in both groups. The clinic results were compared and evaluated via indexes such as left ventricular volume, systolic function etc which were determined by echocardiography. [WTHZ]Results No operation death was found in both groups. In offpump group, there was no perioperative complication. Postoperative cardiac function classification (NYHA) improved significantly (1.0±0.8 grade vs. 2.9±0.3 grade，P=0.001), left ventricular ejection fraction（LVEF） improved significantly (41.0%±4.5% vs. 36.4%±4.8%，P=0.035), and left ventricular [CM(159mm]endsystolic volume index (LVESVI) reduced significantly (52.6±27.7 ml/m2 vs. 79.7±21.4 ml/m2, P=0.003) compared with that before operation. Seventeen cases were followed up, and the followup time was 12-53 months with a mean time of 29 months. No death was found during following up. One case was reoperated 1 year after operation because of severe mitral valve regurgitation. One case had congestive heart failure 3 years after operation with a LVEF of 31% and still in observation. The other cases were fine. In onpump group, there were 3 cases had perioperative complications (Two with neurological complications and one with respiratory failure). Postoperative cardiac function classification (NYHA) improved significantly (1.0±0.6 grade vs. 3.1±0.9 grade，P=0.001). LVEF improved significantly (42.3%±3.2% vs. 35.6%±6.5%, P=0.023). LVESVI reduced obviously (49.3±22.6 ml/m2 vs. 81.3±25.0 ml/m2, P=0.003) compared with that before operation. Fifteen cases were followed up and the followup time was 1260 months with a mean time of 35 months. No death was found during following up and the clinic results were good. No significant difference was observed between the two groups (P>0.05). [WTHZ]Conclusion Offpump LV aneurysm plication repair for LV dyskinetic aneurysm can effectively reduce the volume of LV, improve LVEF and cause less perioperative complications. It is a safe and effective procedure. Its longterm prognosis needs further observation.

参考文献/References

-

备注/Memo

备注/Memo:
-
更新日期/Last Update: 2009-12-29